Natural Birth: at the Hospital or at the Birthing Center?

I’ve experienced three drastically births now: an emergency C-section, a natural VBAC at the hospital and finally a water birth at a birthing center.

The purpose of this post is to give you a side by side comparison of what unmedicated labor and delivery was like for me at a hospital and at a birthing center.

If you’re already certain that you would like to give a natural birth your best shot, but haven’t decided where you want to do it at, this is the post for you. I’m not here to convince you to have a natural birth because I know that’s not for everybody. I’m also not here to sway you toward either the hospital or the birthing center–that’s a personal choice you’ll have to make. But I will reflect on both of my personal experiences honestly to help inform your decision.

(I know that there are two more options that you may consider for natural birth: a midwife at the hospital or a midwife at home. My experience with a midwife at a hospital ended in a c-section and I have not had a home birth, so I will not speak in depth to either of those options.)

So let me start by saying that I had a really positive experience in both settings. It’s a privilege now to even have a choice between two places where the care was excellent with healthy outcomes–I know not everybody has the luxury of a choice.

So let’s get down to the differences:

Peace of Mind

It’s important in either case to ask questions of your health practitioner right from the get go. Don’t wait until you get to your appointment to think up the questions (because you will almost always forget something,) write yourself a list before you go!

Because my first birth was a c-section, I felt most comfortable having a VBAC (vaginal birth after cesarian) with an obstetrician. I did my research when I selected him as many doctors around my city refuse to perform a VBAC. I peppered my OB with questions like:
What is your c-section rate?
How do you feel about VBAC’s?
Will you be the one to deliver my baby or could it be one of your colleagues?
How do you handle past-due pregnancies?
Are you comfortable with unmedicated labor?
Should this birth end in a c-section, are you willing to continue delivering any future babies of mine without judgement?

He answered every question to my satisfaction, and I felt very secure in his hands.

After the successful VBAC, I knew that my body could actually push a baby out, so I researched midwives in my area to find mine. At my consultation with her, my main question was:

What is your transfer rate? 
If a midwife brags about a low transfer rate, that would’ve been a red flag for me. I want to know that my health comes before her reputation, so she isn’t too proud to send me to the hospital if need be.  The answer to this question reveals a lot about a midwife, and I was pleased to find out that my midwife was not ashamed of her 15% transfer rate.

She told me that she has a consulting obstetrician that will meet us at the hospital located just five minutes away. She told me that she would stay with me even if we transferred and that there is a fabulous NICU at this hospital should we need it.

Also, (and this is important) she gets paid either way. That might seem unfair to you as a paying customer, but for her, it means that there is not a total loss of income should we go to the hospital. Some midwives accept insurance or medicare and in either of those cases, she may not get paid her full fee if you transfer. So ask! Again, I want to know that she’ll use her best judgement to send me to the hospital if the baby or I need it without any distracting factors weighing in her mind.

Bottom line: when it comes to birth, plan for the best but prepare for the worst.

Don’t be afraid to ask lots of questions when you meet your healthcare provider and if he or she doesn’t give you peace of mind, find someone else! There are too many doctors and midwives out there for you to see someone who doesn’t make you feel 100% comfortable under their care.

Prenatal Care

Seeing a midwife who only schedules one appointment per hour is SO NICE compared to a busy OB/GYN’s office. There was never a delay with my midwife, and it always felt like we had plenty of time to sort through any questions I had.

I also found that my midwife was very welcoming to my older children whereas my OB and his office staff gave me glares if my toddler raised his voice above a whisper. And because my OB had an unpredictable wait time, it was hard to coordinate childcare. On the other hand, I always felt comfortable bringing my kids to my midwife’s office–she even had toys for them to play with and would hold my toddler while her apprentice checked for baby’s heartbeat!

However, with my midwife, I had to take my own blood pressure and record my own weight. There is no nurse to do that for you at most birthing centers. I also tested my own urine (but I only had to do it once). If you prefer having a nurse do all of that for you, then you may not enjoy the prenatal experience at a birthing center.

In both places, proper blood work was done, the glucose and the Group B strep tests were administered. I had a 20-week ultrasound at both places as well. I felt that there was no lack of care in either place.

Availability

I was fortunate to get the personal cell phone numbers of both my OB and midwife. Not every healthcare provider does this. Both my OB and midwife promised to personally attend my birth, so I wasn’t subjected to whoever was on the rotation for that day. I loved this in both cases.

Not to confuse you, but this was NOT my experience with my first birth. I saw a midwife practice (that functioned a lot like a doctor’s office and delivered at the hospital), and I got whichever midwife was on shift at the hospital when I went into labor (she happened to be the one I liked the least, unfortunately). I know that this is just a humane way of doing things and it guarantees a well-rested somebody to catch your baby, but I really appreciated my second and third birth for this particular reason. I liked seeing the same doctor/midwife through all of my prenatal care and having THAT person deliver my baby. You develop a relationship with this person over the course of nine months, ya know? It’s nice when they can see you through to the end.

Consider if this availability might be important to you orrrr not so much when you choose your healthcare provider.

Pre-labor

My OB wanted me to labor at home until I couldn’t stand the pain. That gave me the power to make the call. I started consistent labor at midnight and got to the hospital around 5am. Much to my disappointment, I was only 3cm dilated when I got there, so we had a long day of labor ahead.

My midwife wanted my contractions to be one minute long before I came in. I started real labor once again at midnight and was feeling ready to head to the birthing center when I called her 1:30am. But, while my contractions were only two minutes apart, they were 30 seconds long. She asked me to try to wait until they were a full minute long. So I did my BEST to labor as long as I could at home, but those contractions were INTENSE, you guys. We finally met her at the birthing center at 5am and found that I was 9cm dilated!

In retrospect, my midwife thought that perhaps I wasn’t timing my entire contraction at home due to a high pain tolerance (I don’t know about that…but…) I kind of wish she would’ve given me the same freedom that my OB did to come in when I felt it was time.

Labor

Okay, now please grant that I hardly labored at my birthing center. I basically got there and it was time to push. BUT this is where the birthing center beat the hospital by a mile for me:

An epidural is NOT an option.
Whether it’s a nurse, doctor or your own mind suggesting that you give up on your natural birth and GET THE EPIDURAL, it is always an option at the hospital. It’s a temptation that you can really fixate on when you’re in the deepest part of the pain. The nice thing about a birthing center is that it simply isn’t an option so you and the staff are focused on natural ways to cope with the pain.

You can eat and drink!
Hospital protocol stinks when you’re in labor. I know, I know, if you go to c-section, it’s safest to have an empty stomach. But my goodness, when I’m pregnant, I feel like I’m dying if I skip just one meal! Laboring for a full day on an empty stomach when you want food is just awful.

The monitoring is minimal.
Those fetal monitors strapped to your contracting belly get uncomfortable. And I wanted to break the hands of the nurses who were frequently adjusting them AS I contracted. A midwife will need to check the fetal heart rate with a doppler throughout labor, but otherwise you need not be hooked to any machine. You are free to walk, bounce, squat, bathe–whatever feels best!

Natural labor is normal.
I had no idea that in 2015, natural labor would still be as rare as it was at the hospital I delivered at. In my little bubble of the world, it is much more normalized than it was at my hospital. And while the care was still excellent, I got a lot of pushback.

My doctor threatened me with pitocin multiple times if I didn’t make as much progress as he thought I should have. He also suggested that an epidural would cause me to relax more so that I would be able to push better (…?) I also had a nurse tell me that refusing the antibiotic eye ointment was illegal (which is NOT true. It’s illegal for THEM to refuse it to their patients.)

The list could go on, but at my birthing center, I tell ya, there was no pushback about anything–only support. It was quiet and peaceful, and I felt like my decisions were honored. The hospital is dealing with so much liability, they have a bit of a cookie-cutter way of doing things–which I understand–but that is precisely what I wanted to get away from for my next birth (and, spoiler alert: I’m really glad I did.)

Delivery

At the hospital, the lights got bright and the bed went up. Nurses I hadn’t seen before swarmed me. One aspect that I liked was that my husband got to see our baby’s head first come out, and it was encouraging to hear him tell me he could see it. My doctor did sort of pull the baby after his head came out (we have video and it makes me wince to see it) and I wonder if that was necessary or if that contributed to my [significant] tearing.

My water birth was a different story. The lights were low. I drank ice water between pushes and my mom wiped my forehead with a cold washcloth. My midwife actually coached my pushing in hopes of keeping tears to a minimum (I still tore, learning to accept that this is what my nine+ pound babies do to me.) She would’ve let me catch my own baby, too, but I was so exhausted, I wanted her to do that. The nice thing about a water birth is that it is discrete for photos and video, but I kind of missed having my husband tell me he could see the baby. Even watching the video that we took of the experience, I wish I could I see more of what was going on down there.

Post-partum–the first hours:

In both cases, the bonding time just after baby was born was completely honored. Nobody insisted on taking baby for weight or measurements.

I did have to hand baby off to deliver my placenta in the tub at my birthing center, which was more difficult than I remember it being at the hospital. I was still holding my baby when the placenta came out at the hospital, and then I continued laying there for 30 minutes of stitching.

At the birthing center, I got out of the tub for a bit, then they refilled it with clean water and herbs. I got back in with baby and it was the coolest thing ever doing his after birth float. His ears were under the water to mimic the sounds of the womb and his body curled up in the position I knew he had assumed in the womb–it was neat! Then I had to get out to get stitches (which wasn’t quite so pleasant)–but in both cases, a local anesthetic was used before stitching, so don’t think you have to go without THAT if you have a midwife.

After all three of my births, I was read pages and pages of information about caring for myself and my baby. This must be standard practice, but it is the last thing I wanted to listen to when I was absolutely exhausted from laboring and also desiring some quiet time with my baby.

Four hours passed by very quickly at the birthing center, and before I knew it, we were strapping our newborn into a car seat and I was slow-walking into daylight. At the hospital, we would’ve just been getting checked into the post-partum floor at that point.

Post-partum–the first days:

After the birthing center, I was home, and that was nice. But as much as I love my home, it is very much my work place. I know how best to keep it, I know where everything is, I know what is in the back of the freezer, I know my older kids’ schedules better than anyone. So, home isn’t nearly as relaxing for me as the hospital was for just that reason. I loved being around my toddler and preschooler, but I could’ve used a day or two away from the noise they make to really rest.

I was fortunate to have my husband and mom with me for the birthing center birth, but they had been up all night with me as I labored. When we got home that day and I needed them to basically wait on me hand and foot, they were tired. Neither of them were on their A-game, and that made me long for a nurse who was fresh on her shift.

I think in the future, I will definitely hire a post-partum doula for the first two or three days after birth. That is when the nursing hurts the most, the postpartum contractions are the most intense, and every muscle in your body aches.

So, while it may seem as though the hospital wins this round (and yes, it mostly does), the one thing I was glad to have passed on was the bottle-feeding pressure. All three of my kids have lost 10% of their body weight in the first two days, and at the hospital, this is cause for alarm. Either start supplementing with formula or breastfeed every two hours (even if baby is sleeping.)

You know what? This is what happens with colostrum. It has very little fat, but is still packed with protein and other essential nutrients for a brand new baby. Nurses should know this, but then that is hospital protocol for you again.

So, I appreciate that there is no pushback at home for exclusive breastfeeding. (Now, if your milk comes in and baby continues to lose weight, THEN you should consider supplementing. But not before then. Let your body and baby establish the natural rhythm they were meant for first.)

My midwife did visit me at home 36 hours after the birth and I went in to see her after two weeks. I liked that my midwife was able to give the baby a checkup at the same time as me. In both cases, we had to get to the pediatrician within the first week, and that’s always a difficult first outing. But doable.

The Cost

So this can certainly vary from midwife to midwife and hospital to hospital. But, just to give you a ballpark, our birthing center birth (including all prenatal and follow-up care) cost about $5,000 and our hospital birth (not including prenatal or follow-up care) was around $10,000. Add to the hospital cost a $1,300 bill for newborn care (and this was with no health complications at all.) This is unmedicated birth in both cases.

The cost may look different for you depending on your insurance (or lack thereof.) I will say that for our third birth, we were blessed to be a part of the Samaritan Ministries network and had all costs 100% covered (even prenatal vitamins!) If you are a Christian, I cannot more highly recommend this alternative to traditional insurance–(especially for my fellow sisters in their childbearing years!)

I recently had a friend pass on the insurance that her work offered and sign up with Samaritan instead. She told me that the monthly cost for her insurance with her baby added to it was significantly higher than Samaritan’s monthly cost PLUS she had to pay a high deductible–which Samaritan does not have. Click here to learn more about Samaritan — and if you do sign up because of this blog post, would you kindly list me (Katie Skero from Porter, Texas)  as your referrer? I don’t make money from this, but my monthly cost is reduced for a month which is a blessing to my family. :)

 

So there you have it, my take on both of my natural birth experiences. If you read all 3000 of these words, bravo to you. We should be friends. And while I want to be as unbiased as possible, you may have guessed just from reading that should I be blessed with another baby, I will choose the birthing center again. The support there far outweighed the “comforts” of the hospital. The next time, however, I will hire a postpartum doula for the first few days at home. I hope you’ll make a decision that best fits you, your preferences, and your medical needs.

I’d love to hear from you! Please tell me about your birth experiences or plans in the comments!

 

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